Brachytherapy for localized prostate cancer in the modern era: a comparison of patient-reported quality of life outcomes among different techniques

• Authors: Tiffany M. Morgan, Emory University; Robert H. Press, Emory University; Patrick K. Cutrell, Emory University; Chao Zhang, Emory University; Zhengja Chen, Emory University; Sara Rahnema, Emory University; Martin Sanda, Emory University; John Pattaras, Emory University; Pretesh Patel, Emory University; Ashesh Jani, Emory University; Peter Rossi, Emory University
• Journal Title: Journal of Contemporary Brachytherapy
• Volume: Volume 10, Number 6
• Publisher: Termedia Publishing | 2018-01-01, Pages 495-502
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.5114/jcb.2018.81024
• Subjects: Health Sciences, Oncology; Health Sciences, Radiology; Health Sciences, Toxicology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Radiology, Nuclear Medicine & Medical Imaging; brachytherapy; quality of life; prostatic neoplasms; DOSE-RATE BRACHYTHERAPY; RADIATION-THERAPY; RADICAL PROSTATECTOMY; TREATMENT SCHEDULES; RISK; TRIAL; INTERMEDIATE; MONOTHERAPY; TOXICITY; SURVIVAL

Abstract

Purpose: To report our institutional quality of life (QOL) data for low-dose-rate (LDR) monotherapy (LDR mono), high-dose-rate (HDR) monotherapy (HDR mono), and EBRT with an HDR brachytherapy boost (HDR boost). Material and methods: The charts of 165 patients with localized adenocarcinoma of the prostate treated with LDR monotherapy (LDR mono), HDR monotherapy (HDR mono), and EBRT with an HDR brachytherapy boost (HDR boost) at a single institution between 2012 and 2015 were reviewed. All patients completed the American Urological Association symptom score (AUASS) and Expanded Prostate Index for Prostate Cancer – Clinical Practice (EPIC-CP) quality of life assessments prior to treatment and at least one follow-up survey. Time points included baseline, ≤ 2 months, 2-≤ 6 months, 6-≤ 12 months, 12-≤ 18 months, 18-≤ 24 months, 24-≤ 30 months, and > 30 months. Linear mixed models were performed to test for significant changes and differences in each outcome over time. Results: Mean follow-up was 19.5 months. All major functional QOL domains were affected after treatment with brachytherapy for localized prostate cancer. All domains improved over time, with the exception of sexual function scores for all groups and urinary incontinence scores for the HDR mono group. Patients treated with LDR did have higher AUA, irritability/obstructive symptoms, incontinence, bowel, and QOL scores acutely compared to the HDR and HDR + boost groups. Vitality scores were significantly worse in the HDR boost group both acutely and at the > 30-month time point. Conclusions: Patients receiving HDR brachytherapy had lower acute urinary and rectal toxicity compared to the patients receiving LDR, even when combined with EBRT. However, long-term toxicity was similar.